Your Name Your Organization Phone Email Address (Where is the presentation?)
Which programs would you like us to provide? Passport to Preparedness (all grades) - recognizing and preparing for disasters
Basic Aid Training (1st-6th grade) - a brief course on First Aid and emergency preparedness
First Aid Workshop (6th-12th grade) - one hour, non-certified course on First Aid and CPR
Info Table (all grades) - information about youth volunteer opportunities
What dates and times would you like us to present? If you are suggesting specific dates, please provide at least three options. What is the parking situation? Is there a designated Visitor Lot, street parking, etc? We may be bringing boxes of materials, so if there is a loading/unloading zone at your building, please indicate that, as well. Estimated number of youth in class or group Youth audience age range
Are there special needs? Learning disabilities
English language learners
Is an interpreter needed? Yes
No
Do your students speak any of these languages in the home? Spanish
Vietnamese
Somali
Amharic
Russian
Chinese
Other
Have the youth participated in a Red Cross program in the past? Yes
No
Don't know
If yes, which ones? Basic Aid Training
Community Disaster Education
Other
Is the requested program related to what the youth are learning Yes
No
Don't know
Do you have a disaster plan for your facility? Yes
No
Don't know
If not, would you like help developing one? Yes
No
Is your staff trained in first aid and CPR? Yes
No
Don't know
Length of class periods Does this vary by day? If so, please provide schedule
Does the school have a plan for emergencies and disasters? Yes
No
Don't know
Does the school have disaster kits? Yes
No
Don't know
Has the staff received training for emergencies and disasters? Yes
No
Don't know The Red Cross can provide access to online resources to enhance learning. These programs could be used in computer/media classes following our presentation.
Would you be interested in more information about online media? Yes
No
What are the badge requirements you would like for this class? Note: we may not be able to cover all of the badge requirements. What is the goal of this event? Who is the audience? How many people do you estimate will attend? What other groups are being asked to attend? What would you like to see from the Red Cross?
Is the event indoor or outdoor? Yes
No
Will you provide a table and chairs? Yes
No
Setup and breakdown time? Is there a schedule or agenda for the event? Are there any costs we need to account for? Thank you for completing the Red Cross Program Request! We look forward to working with your group. If you have any questions about your request, please contact our Youth & Young Adult Program Educator at 206-726-3574.
